文章摘要
加速术后康复方案依从性与妇科肿瘤微创手术患者预后的相关性
Correlation between compliance with enhanced recovery after surgery protocol and postoperative outcomes in patients undergoing gynecological oncology minimally invasive surgery
  
DOI：10.12089/jca.2026.01.004
中文关键词: 加速术后康复  依从性  住院时间  并发症  妇科肿瘤手术
英文关键词: Enhance recovery after surgery  Compliance  Length of stay  Complications  Gynecologic oncology
基金项目:贵州省科学技术基金（黔科合支撑〔2019〕2815号）
作者单位E-mail
蒋泽耀 563000,遵义医科大学第一临床医学院  
王璐 贵州省人民医院麻醉科  
秦晨光 贵州省人民医院麻醉科  
彭晶 贵州省人民医院麻醉科  
马熠 贵州省人民医院麻醉科  
刚绍鹏 贵州省人民医院麻醉科  
方开云 贵州省人民医院麻醉科 fangkaiyun@sina.cn 
訾聃 贵州省人民医院妇科  
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中文摘要:
      
目的：分析并探讨加速术后康复（ERAS）依从性与妇科肿瘤微创手术患者预后的相关性。
方法：选择2020年2月至2024年1月择期行腹腔镜或机器人辅助下子宫附件切除术、子宫附件切除术加盆腔和/或腹主动脉旁淋巴清扫术等妇科肿瘤微创手术患者，年龄18～74岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级。所有患者遵循基于ERAS指南制定的标准化24项要素方案，根据ERAS要素的执行情况将患者分为两组：依从性≤70%的患者为低依从性组（L组），依从性>70%的患者为高依从性组（H组）。主要指标为术后住院时间（LOS）。次要指标包括术中舒芬太尼用量、术后30 d内并发症发生及再入院情况，以及术后6、12、24、48、72 h的VAS疼痛评分，术后首次饮水及进食时间，首次肛门排气时间，术后第1天输液总量。
结果：共纳入患者461例，L组227例，H组234例。与L组比较，H组术后LOS明显缩短，术中舒芬太尼用量明显减少，术后30 d内并发症发生率明显降低，术后首次饮水时间、进流质食物、进固体食物、首次肛门排气时间、下床活动时间均明显缩短，术后第1天输液总量均明显减少（P＜0.05）。多因素线性回归分析显示，在控制年龄、术前合并冠心病、术前白蛋白、ASA分级、手术方式及手术时间等协变量后，依从性与术后LOS呈显著负相关，依从性每提高1%，术后LOS平均缩短0.12 d（β=-0.120， 95%CI -0.163～-0.077， P<0.001）。两组术后30 d内再入院率及术后6、12、24、48、72 h VAS疼痛评分差异无统计学意义。
结论：ERAS依从性与复杂性妇科肿瘤微创手术患者预后存在明显相关性。较高ERAS依从性缩短术后LOS，且不增加术后30 d内再入院风险。
英文摘要:
      
Objective: To analyze and explore the correlation between enhanced recovery after surgery (ERAS) compliance and prognosis in patients undergoing minimally invasive gynecologic oncology surgery.
Methods: Patients aged 18-74 years, BMI 18.5-30.0 kg/m2 and ASA physical status Ⅱ or Ⅲ who underwent elective minimally invasive gynecological tumor surgeries such as laparoscopic or robot-assisted hysterectomy with adnexectomy, hysterectomy with adnexectomy plus pelvic and/or para-aortic lymph node dissection between February 2020 and January 2024 were included. All patients followed a standardized 24-element ERAS protocol. Based on ERAS element compliance, patients were divided into a low-compliance group (group L, ≤ 70% compliance) and a high-compliance group (group H, > 70% compliance). The primary outcome was length of hospital stay (LOS). Secondary outcomes included 30-day postoperative complications and readmission rates, visual analog scale (VAS) pain scores at 6, 12, 24, 48, and 72 hours postoperatively, time to first oral intake, first flatus, and ambulation, intraoperative sufentanil consumption, and total fluid volume on postoperative day 1.
Results: A total of 461 patients were enrolled, 227 patients in group L and 234 patients in group H. Compared to the group L, the group H had significantly shorter LOS, reduced intraoperative sufentanil use, lower 30-day complication rates, earlier resumption of oral intake, flatus, and ambulation, reduced and postoperative fluid volume (P < 0.05). Multivariate linear regression showed that after adjusting for covariates (age, preoperative coronary artery disease, albumin level, ASA physical status, surgical approach, and duration), ERAS compliance was independently associated with shorter LOS (β = -0.120, 95% CI -0.163 to -0.077, P < 0.001). No significant differences were observed in 30-day readmission rates or VAS pain scores between two groups.
Conclusion: ERAS compliance is significantly correlated with postoperative outcomes in patients undergoing minimally invasive surgery for complex gynecological tumors. Higher ERAS compliance could reduce postoperative LOS and does not increase the risk of readmission within 30 days.
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